APPLICATION FOR LOAN

Transcription

1 APPLICATION FOR LOAN XI PSI PHI FRATERNITY WILLIAM E. KOCH STUDENT LOAN FUND Board of Trustees Dr. Thomas J. Bonomo, Chairperson Dr. Joseph J. Schwarz 22 Bobolink Lane 790 Tanglewood Court Northport, NY Deerfield, IL General Information: Dr. Jonathan M. Ash 4777 Higbee Avenue NW Canton, OH Inasmuch as other loans are available that are designed for long-term assistance and due to the limited funds available to the Xi Psi Phi-William E. Koch Student Loan Fund, this fund must be considered as an "emergency loan" fund. This fund is available only to needy junior, senior or graduate dental students in good standing at an accredited dental school, regardless of fraternity affiliation. At this time the maximum loan is $1,000. A student may apply for a second loan the following year. Because of the limited funds available, monthly payments on the loan must be started ninety (90) days after graduation. The minimum monthly payment will be $50 for each loan. There will be an interest charge at a rate of five percent (5%) per annum on the balance of the loan starting the day the loan check is dated. The interest will be compounded biannually (January 1 and July 1). Sixty (60) days after the 90-day grace period, if no payment has been made, the loan will be overdue and the rate will increase to ten percent (10%) per annum. It will be necessary for you to sign a promissory note (included in the application). You will also be asked to have a cosigner. The cosigner may not be your spouse or another dental student. Demographic Information: (Please type or print) Name LAST FIRST MIDDLE Local address STREET CITY STATE ZIP Telephone number ( ) Social Security No.

2 Cellular Phone number ( ) Address Permanent address STREET CITY STATE ZIP Dental School you attend Chapter's name Graduation date: Month Year Class: Junior Senior Date of birth: / / Married: Yes No If married last name is different from the above please state it: Number of dependents Number of children Ages Name of parents or guardian Address STREET CITY STATE ZIP Occupation Telephone No. ( ) Financial Information: Will it be impossible or difficult to attend dental school without financial assistance? Annual income of parents or guardian? How many dependent children in your parent's family? What is your present total indebtedness for education? Banks Government Loans Other Is spouse employed? What occupation? What is your monthly income including spouse? Do you have an automobile? Year Make What is the appraised value of any property you own other than the automobile? List church, hometown civic clubs or other organizations you have approached for possible financial aid: Outcome: List scholarships you are now holding:

3 Amount of each scholarship: Personal Statement: Explain why you need a loan. How much aid are you requesting in this application? I certify that all the above statements are true and that if my request for financial aid is approved I hereby agree to the loan conditions in the General Information statement of this application. After the application is completed, it is recommended that you make a copy for your records and place the application, which includes the Promissory Note in an unsealed stamped envelope addressed to: Dr. Thomas J. Bonomo 22 Bobolink Lane Northport, NY and give the envelope to your Chapter Advisor for his/her comments. The Chapter Advisor will then mail the application to Dr. Bonomo for you.

4 PROMISSORY NOTE XI PSI PHI FRATERNITY WILLIAM E. KOCH STUDENT LOAN FUND For value received, I promise to pay to the order of Xi Psi Phi Fraternity's William E. Koch Student Loan Fund the principal sum of $ plus interest at the rate of five percent (5%) per annum compounded biannually on all unpaid amounts from the date of the bank check until the full amount is paid. I also agree that payments of a minimum of fifty dollars in United States currency (U.S. $50.00) are to begin within ninety (90) days after graduation. I also understand and agree that after sixty (60) days of no payment the loan will be considered overdue and the interest rate will increase to ten percent (10%) per annum. COSIGNER: LAST NAME FIRST MIDDLE (Note: Cosigner may not be spouse or another dental student. Please print or type all responses except signature.) Relation to loanee: Address: STREET CITY STATE ZIP Telephone number(s): ( ) ( ) HOME BUSINESS Occupation: I,, as cosigner of the loan, agree to the conditions of the loan and am ready to make full payment of the loan if the loanee defaults.

5 Comments by the Chapter Advisor: If you were a Trustee of this fund would you grant this loan? Printed name: Telephone number: ( ) Thank you for your comments. Please seal the envelope and mail as directed Date application was received: / / Vote of Trustees: Yes No Yes No Yes No Letter of Trustees' action sent: / / Check sent: / /

6 Loan Due: / / XI PSI PHI FRATERNITY Office of the William E. Koch Student Loan Fund Dr. Thomas J. Bonomo, Chair TO: FROM: SUBJECT: All College Chapter Advisors Board of Trustees, Student Loan Fund Student's Application for Loan The Board of Trustees would like to enlist your help in evaluating the applications we receive for student loans. The loans are meant for an emergency in which a junior, senior or graduate student needs money to buy equipment for school or to pay bills. The Fund has a limited amount of money; therefore, the loans are $1,000 each. The student can apply for a second loan. The Trustees are limited in their knowledge of the student's circumstances by what is written on the application. We would like you to round out the application by telling us what is not on the application. Such as: Is the student a hard worker and conscientious? Is the student a good Fraternity member? Is he/she active in the Fraternity and the school? Any other pertinent information would be appreciated. A copy of the new application for a loan is attached. Please read through the application to acquaint yourself with the questions. You will note that on the bottom of the second page there are instructions to the student on how to handle the application. The application is to be given to you for your comments (last page). If you would rather not comment for some reason, please say so. Please seal the envelope and mail the application. The correct postage should have been placed on the envelope by the student. You may obtain additional copies of the application from Dr. Thomas J. Bonomo at the address and telephone number listed below; the Supreme Chapter Office, 1623 Washington Avenue #300, Alton, IL 62002; Phone: ; Fax: ; XIPSIPHI@hotmail.com; or you may download it from the website: The Trustees thank you for any help you can give. 22 Bobolink Lane, Northport, NY

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